EP3089787B1 - Système pour une arcthérapie stéréotaxique à intensité modulée - Google Patents

Système pour une arcthérapie stéréotaxique à intensité modulée Download PDF

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EP3089787B1
EP3089787B1 EP15704112.0A EP15704112A EP3089787B1 EP 3089787 B1 EP3089787 B1 EP 3089787B1 EP 15704112 A EP15704112 A EP 15704112A EP 3089787 B1 EP3089787 B1 EP 3089787B1
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gantry
globe
radiation
patient
external source
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EP3089787A1 (fr
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Xinsheng Cedric Yu
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1042—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy with spatial modulation of the radiation beam within the treatment head
    • A61N5/1045—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy with spatial modulation of the radiation beam within the treatment head using a multi-leaf collimator, e.g. for intensity modulated radiation therapy or IMRT
    • A61N5/1047—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy with spatial modulation of the radiation beam within the treatment head using a multi-leaf collimator, e.g. for intensity modulated radiation therapy or IMRT with movement of the radiation head during application of radiation, e.g. for intensity modulated arc therapy or IMAT
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/44—Constructional features of apparatus for radiation diagnosis
    • A61B6/4429—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units
    • A61B6/4435—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being coupled by a rigid structure
    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computed tomography [CT]
    • A61B6/032—Transmission computed tomography [CT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computed tomography [CT]
    • A61B6/032—Transmission computed tomography [CT]
    • A61B6/035—Mechanical aspects of CT
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/44—Constructional features of apparatus for radiation diagnosis
    • A61B6/4429—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/44—Constructional features of apparatus for radiation diagnosis
    • A61B6/4429—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units
    • A61B6/4435—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being coupled by a rigid structure
    • A61B6/4441—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being coupled by a rigid structure the rigid structure being a C-arm or U-arm
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B6/44—Constructional features of apparatus for radiation diagnosis
    • A61B6/4429—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units
    • A61B6/4452—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being able to move relative to each other
    • A—HUMAN NECESSITIES
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    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
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    • A61N5/1077—Beam delivery systems
    • A61N5/1081—Rotating beam systems with a specific mechanical construction, e.g. gantries
    • A61N5/1082—Rotating beam systems with a specific mechanical construction, e.g. gantries having multiple beam rotation axes
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    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A61N2005/1052—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using positron emission tomography [PET] single photon emission computer tomography [SPECT] imaging
    • A—HUMAN NECESSITIES
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    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A61N2005/1054—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using a portal imaging system
    • A—HUMAN NECESSITIES
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    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A61N2005/1055—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using magnetic resonance imaging [MRI]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A61N2005/1061—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using an x-ray imaging system having a separate imaging source
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1064—Monitoring, verifying, controlling systems and methods for adjusting radiation treatment in response to monitoring
    • A61N5/1065—Beam adjustment
    • A61N5/1067—Beam adjustment in real time, i.e. during treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1064—Monitoring, verifying, controlling systems and methods for adjusting radiation treatment in response to monitoring
    • A61N5/1069—Target adjustment, e.g. moving the patient support
    • A61N5/107—Target adjustment, e.g. moving the patient support in real time, i.e. during treatment

Definitions

  • the present disclosure relates to radiation therapy, in particular a system for delivering focused radiation from outside of a patient's body to a target inside the patient.
  • the system aims intensity-modulated external radiation beams from a wide solid angle to deliver a focal dose of radiation to the target.
  • Radiation therapy is used to treat cancers and other conditions in patients. About half of all cancer patients receive some type of radiation therapy sometime during the course of their treatments.
  • One commonly used form of radiation therapy is external beam radiation therapy.
  • external beam radiation therapy a high-energy, x-ray beam generated by a machine, usually a linear accelerator (linac), a gamma-ray beam emitted from an isotope, or charged particles generated from a particle accelerator is/are directed at a tumor or cancerous cells (i.e., the "target") inside the patient's body. While the radiation kills the cancerous cells, it also harms normal tissue and organs in the vicinity of the tumor/cancerous cells in the patient.
  • the goal in radiation therapy is to deliver the required dose of radiation to the target volume, while minimizing the radiation dose to surrounding normal tissue that may cause complications and harm to the patient.
  • 3D-CRT A common type of external-beam radiation therapy is called three-dimensional conformational radiation therapy (3D-CRT).
  • 3D-CRT allows the radiation beams to be shaped from a limited number of fields to conform to the beam's eye-view of the target area.
  • a more advanced method of radiation treatment is intensity-modulated radiation therapy (IMRT), which provides more freedom than 3D-CRT by allowing the intensities of the radiation beams to vary within a radiation field in addition to field shaping.
  • IMRT intensity-modulated radiation therapy
  • the goal of IMRT is to increase the radiation dose to the areas that need it and reduce radiation exposure to specific sensitive areas of surrounding normal tissue.
  • the treatment planning system optimizes the beam intensity distribution to achieve maximally this goal.
  • IMRT can reduce the risk of some side effects, such as damage to the salivary glands (which can cause dry mouth or xerostomia), when the head and neck are treated with radiation therapy ( Veldeman et al., "Evidence behind use of intensity-modulated radiotherapy: A systematic review of comparative clinical studies," Lancet Oncology 9(4): 367-375 (2008 ); and Erratum in: Lancet Oncology 9(6): 513 (2008 )).
  • 3D-CRT and IMRT are typically delivered using a linear accelerator mounted on a C-arm gantry (as shown in Fig. 1 ) or a ring-like gantry, which is capable of only single plane rotation.
  • Tomotherapy Detorie, "Helical Tomotherapy: A new tool for radiation therapy," J. Amer. Coll. Radiol. 5(1): 63-66 (2008 )
  • intensity-modulated arc therapy IMAT
  • Yu "Intensity modulated arc therapy using dynamic multi-leaf collimation: An alternative to Tomotherapy”
  • tomotherapy the patient is translated linearly as the source of radiation is making circular movements, thereby the relative motion of the radiation beam and the patient is a helix.
  • SRS 34(3): 141-148 (2009 ) is a dedicated SRS system for treating intracranial lesions.
  • Gantry-based linear accelerator systems are also used for SRS. Both allow radiation beams to be incident on the target from directions outside the transverse plane.
  • SBRT is used to treat tumors that lie outside the brain. SBRT is usually given in more than one treatment session. Methods of extending the Gamma Knife concept to the rest of the body are also proposed, such as with the GammaPod system for the treatment of breast cancer ( Yu, et al., "GammaPod-A new device dedicated for stereotactic radiotherapy of breast cancer," Med. Phys.
  • Maurer and colleagues at Accuray, Inc. have proposed a number of alternative solutions using a fixed ring gantry, rather than a robotic arm (U.S. Pat. App. Pub. No. US 2011/0210261 A1 ; U.S. Pat. App. Pub. No. US 2011/0301449 A1 ; and U.S. Pat. App. Pub. No. US 2012/0189102 A1 ). While ring gantries are desirable for diagnostic imaging, where a single transverse plane or limited non-coplanar angles are used for the imaging beams, they are not ideal for treatment where a larger range of non-coplanar angles is desirable.
  • the radiation beams are preferably directed to the target from one side of the patient's transverse axis, often from a large angle relative to this axis.
  • most beams should be directed from the upper hemisphere (above the top of the patient's head) rather than from the lower hemisphere.
  • the ring gantry systems proposed by Maurer and colleagues have limited ability to take advantage of such anatomical preferences or achieve highly non-coplanar beam directions.
  • the present disclosure seeks to overcome the limitations of the attendant systems and methods currently available in the art by providing, among other things, a method to allow radiation beams of varying intensity and field shape to be focused from a broad solid angle by combined longitudinal and latitudinal rotations of the radiation source.
  • the present disclosure describes a method and a radiation delivery system to increase further the utility and clinical efficacy of photon-based treatment systems via increasing the degrees of freedom in beam delivery beyond that achievable with existing IMRT and SRS/SBRT systems. Specifically, this is achieved by allowing intensity-modulated photon beams to be delivered from a very large number of beam directions, including those which are highly non-coplanar.
  • the solid angle range includes all longitudinal angles (about the patient's longitudinal axis) and a broad range of latitudinal angles.
  • the methods and system combine, in a practical design, the geometric focusing of SRS/SBRT and intensity modulation of IMRT, thereby providing capabilities not attainable by either IMRT or SRS/SBRT alone.
  • a globe gantry for longitudinally and latitudinally rotating an external source of radiation, such as at least one external source of radiation, concentrically around an isocenter placed in a target to be irradiated.
  • the globe gantry has a central axis intersecting the isocenter and comprises as components (i) a front opening ring with its origin on the central axis of the globe gantry, (ii) at least one arc-shaped, gantry support arm, which has a front end and a rear end and is part of a circle, (iii) an external source of radiation, such as at least one external source of radiation, which is mounted on at least one arc-shaped, gantry support arm and can move along the arc-shaped, gantry support arm to rotate latitudinally about the isocenter, and optionally, a beam stopper, which is mounted on at least one arc-shaped, gantry support arm, and wherein the beam stopper is on the opposite side of the globe gantry from
  • the front opening ring is attached to the front end of the at least one arc-shaped, gantry support arm.
  • the rear rotational axle is attached to the rear end of the at least one arc-shaped, gantry support arm.
  • the front opening ring and the rear rotational axle are supported by the support base and the rear housing.
  • the front opening ring and the rear rotational axle can rotate around the central axis causing the external source of radiation to rotate longitudinally.
  • the external source of radiation is a linear accelerator or a radioisotope teletherapy device.
  • the external source of radiation can move along the length of the at least one arc-shaped, gantry support arm on which it is mounted at a variable speed.
  • the system comprises (i) a globe gantry, (ii) a patient platform, (iii) a patient platform support, and, optionally, (iv) a shield.
  • the patient platform can be independently moved in either direction along the length of the patient platform or z-dimension, in either direction along the width of the patient platform or x-dimension, and/or in either direction above or below the patient platform or y-direction.
  • the movement(s) of the patient platform is/are in synchrony with the longitudinal and latitudinal rotations of the radiation source and are controlled centrally by the control unit that coordinates all the movements during irradiation of the patient.
  • the patient platform support supports the patient platform.
  • the shield separates the patient from the rest of the system.
  • the system can further comprise (v) at least two straight support beams, (vi) an x-ray tube, and (vii) an x-ray detector array.
  • the x-ray tube is mounted on at least one straight support beam on one side of the globe gantry.
  • the x-ray detector array is mounted on at least one straight support beam on the opposite side of the globe gantry from the x-ray tube and can move along the lengths of the at least two straight support beams to which they are mounted.
  • the at least two straight support beams are parallel with the central axis of the globe gantry.
  • the x-ray tube and the x-ray detector array are mounted on a separate rotational axle, and can move along the lengths of the at least two straight support beams to which they are mounted.
  • the x-ray detector array can be one-dimensional or multi-dimensional, such as two-dimensional.
  • the two straight support beams are supported at the front end by a bearing mounted on the front ring of the globe gantry and at the rear end by a bearing coaxial with, but separate from, the rear rotational axle of the globe gantry.
  • the two straight support beams can rotate independently, i.e., longitudinally independently, of the rotation, i.e., longitudinal rotation, of the globe gantry.
  • the system can further comprise (viii) a computed tomography (CT) imaging system, a magnetic resonance imaging (MRI) system, or a positron emission tomography (PET)/computed tomography (CT) imaging system positioned adjacent to the front opening ring of the globe gantry, wherein the CT imaging system, the MRI system, or the PET/CT imaging system can provide on-board imaging guidance.
  • CT computed tomography
  • MRI magnetic resonance imaging
  • PET positron emission tomography
  • CT positron emission tomography
  • CT computed tomography
  • a method of irradiating a target in a patient comprises directing a beam of radiation from an external source of radiation, such as at least one external source of radiation, at the target in the patient from numerous directions (the directions can be so numerous as to be considered vast) in a broad solid angle.
  • the external source of radiation is longitudinally rotated around the patient about an axis. Simultaneously with the longitudinal rotation or sequentially to the longitudinal rotation, in either order (i.e., either before or after), the external source of radiation can be rotated latitudinally via translation along a circular trajectory. Together, the longitudinal and latitudinal rotations of the external source of radiation in effect move the source of radiation in a trajectory that lies on the surface of a sphere.
  • the range of latitudinal rotation is sufficient to allow large non-coplanar beam angles at one or both ends of the rotation range.
  • the central axis of the beam of radiation is focused on a fixed point in space throughout all rotations of the external source of radiation. This point is the "isocenter" or the intersection of the axes of longitudinal and latitudinal rotation.
  • the external source of radiation is preferably, and even desirably, longitudinally rotated and latitudinally rotated concentrically around a common isocenter.
  • the intensity of the beam of radiation, the shape of the aperture of the beam of radiation, or both the intensity and the shape of the aperture of the beam of radiation can be varied, such as during movement of the external source of radiation, i.e., during irradiation throughout different points of longitudinal and/or latitudinal rotation, or during maintenance of the external source of radiation at a single/static location.
  • the speed of longitudinal rotation of the external source of radiation, the speed of latitudinal rotation of the external source of radiation, or both the speed of longitudinal rotation and the speed of latitudinal rotation of the external source of radiation can be varied.
  • the breadth of the solid angle from within which the beam of radiation is directed can vary depending on the location of the target in the patient being irradiated.
  • the path of the external source of radiation is a zigzag as shown in Fig. 6(b) , which illustrates the locus of the external source of radiation with slow longitudinal rotation and back and forth latitudinal rotation, whereby the locus of the beam source forms a zigzag pattern on the surface of a sphere.
  • the path of the external source of radiation is connected segments of helices of opposite directions.
  • the method can further comprise continuously or discontinuously moving the patient during irradiation, thereby allowing the radiation focal point to move dynamically within the target or be statically placed at one or more positions in and around the target.
  • This method is referred to as stereotactic intensity-modulated arc therapy (SIMAT).
  • a globe gantry 21 for longitudinally and latitudinally rotating an external source of radiation concentrically around an isocenter placed in a target to be irradiated is also provided.
  • the globe gantry 21 has a central axis intersecting the isocenter and can rotate the external source of radiation 24 throughout a 360° range about the central axis. This movement is referred to herein as “longitudinal rotation,” and the external source of radiation is said to “rotate longitudinally” or “longitudinally rotate” or to be “longitudinally rotated” when it rotates around the central axis.
  • the globe gantry 21 can rotate in either direction, i.e., clockwise and counterclockwise.
  • the globe gantry 21 can rotate at a variable speed.
  • the globe gantry 21 comprises the following components: (i) a front opening ring 22 with its origin on the central axis of the globe gantry 21, (ii) at least one arc-shaped, gantry support arm 23, which has a front end and a rear end and is part of a circle with its origin on the central axis of the globe gantry, (iii) an external source of radiation ( 24 ; also referred to as a "radiation generating device,” a “radiation-emitting device,” and a “radiation head"), which is mounted on at least one arc-shaped, gantry support arm 23, and, optionally, a beam stopper, which is mounted on at least one arc-shaped, gantry support arm 23, and wherein the beam stopper is on the opposite side of the globe gantry 21 from the external source of radiation 24, (iv) a rear rotational axle 25 with an axis along the central
  • the front opening ring 22 is attached to the front end of the at least one arc-shaped, gantry support arm 23.
  • the front opening ring 22 is attached to the front ends of at least two arc-shaped, gantry support arms 23, which are separated by longitudinal angles of 180°, or at least two pairs of adjacent arc-shaped, gantry support arms 23, which pairs are separated by longitudinal angles of 180°.
  • the curvature of the arc-shaped, gantry support arm(s) 23 enables movement of the external source of radiation 24 along a circular path with a fixed origin, i.e., the isocenter, that lies on the rotational axis of the globe gantry 21 and, when present, the beam stopper.
  • the front opening ring 22 desirably provides support and rigidity.
  • the front opening ring 22 is supported by rollers 30, bearings, or the like set on the support base 27, such that the front opening ring 22 can freely rotate on the support base 27.
  • the rear, rotational axle 25 is attached to the rear end of the at least one arc-shaped, gantry support arm 23 and facilitates longitudinal rotation of the globe gantry 21. Longitudinal rotation also can be achieved by driving the front opening ring 22.
  • the rotational axle is attached to the rear ends of the at least two arc-shaped, gantry support arms 23, and the two arc-shaped, gantry support arms 23 form part of a circle.
  • the arc-shaped, gantry support arms 23 are affixed to, and extend outwardly and forward from, the rear rotational axle 25.
  • the front opening ring 22 and the rear rotational axle 25 are supported by the support base 27 and the rear housing 26.
  • the front opening ring 22 and the rear rotational axle 25 can rotate around the central axis.
  • Such a configuration when rotated about the central axis, occupies a space resembling part or all of a sphere or a globe.
  • the globe gantry can be slightly more or less hemispheric.
  • Driving mechanisms can be attached at any suitable place(s) on the globe gantry.
  • driving mechanisms can be attached to the rear, rotational axle 25 and/or the front, opening ring 22.
  • a slip ring is used to supply the electricity from the rear housing 26 to the power sources of the external source of radiation 24 mounted on the globe gantry, and to establish communication links between components, such as sensors, controllers, etc., mounted on the globe gantry and the stationary rear housing.
  • the slip ring also may be used to transfer cooling water to and from the rotating globe gantry 21. Slip-ring technology is not necessary when the globe gantry 21 is rotated back and forth with a maximum range of rotation in a single direction that does not significantly exceed 10 turns (i.e., 3600°).
  • the driving mechanism of the globe gantry 21 is designed to prevent unintended rotation in the event that there is a loss of power and the weight on the globe gantry 21 is not balanced around the globe.
  • a non-reversible, drivable gear mechanism is used. Such a mechanism serves to protect the patient and the globe gantry 21, as well as a system 20 comprising the globe gantry.
  • the globe gantry can have any suitable radius. Desirably, the globe gantry 21 has a radius that is large enough for the intended application.
  • the diameter of the front opening ring should be from 60 cm to 100 cm, sufficient to allow a patient, in particular a human patient, to be placed in the interior space of the globe gantry 21 and, optionally moved in three dimensions within the interior space of the globe gantry 21.
  • the opening can be smaller.
  • the external source of radiation 24 is mounted on a pair of adjacent arc-shaped, gantry support arms 23 for greater stability and better control of the external source of radiation 24 when it is moving along the length(s) of the arc-shaped, gantry support arm(s) 23.
  • the external source of radiation 24 can move or translate along the length(s) of the arc-shaped, gantry support arm(s) 23 to which it is attached at a constant speed or a variable speed.
  • the speed of longitudinal rotation and the speed of latitudinal rotation of the external source of radiation 24 can be, but need not be, and preferably are not, constant.
  • the trajectory of the source of radiation 24 under such conditions is not a perfect spherical helix.
  • the longitudinal and latitudinal rotation of the external source of radiation 24 is generally not mono-directional, i.e., it can be rotated back and forth in both directions as needed, and each movement in one direction can be complete or incomplete, i.e., longitudinal rotations that are not necessarily throughout 360 degrees and latitudinal rotations that do not necessarily involve translation of the source along the entire length(s) of the arc-shaped, gantry support arm(s) 23.
  • the starting and stopping positions along the arc-shaped, gantry support arm(s) 23 can vary with the longitudinal angle of the location of the external source of radiation 24.
  • the axis of the radiation beam always points to the origin of the sphere.
  • the range of the latitudinal angles is not symmetrical about the plane through the isocenter and perpendicular to the longitudinal axis of the globe gantry 21.
  • this asymmetry of latitudinal rotation is about the vertical plane through the isocenter and transverse to the patient platform 28.
  • An alternative mechanical system for moving at least one source of radiation in a sphere, while keeping the beam focused on a fixed location in space is also provided.
  • the radiation head 24 is fixed on the arc-shaped, gantry support arm 23, and the arc-shaped, gantry support arm 23 and the rear, rotational axle 25 are translated, causing the external source of radiation 24 to rotate latitudinally.
  • a system 20 for irradiating a target in a patient comprises the following components: (i) a globe gantry 21 as described herein, (ii) a patient platform 28, which is positioned along the central axis of the globe gantry 21 and which comprises a first end and a second end, (iii) a patient platform support 29, which supports the patient platform 28, and, optionally, (iv) a shield, which separates the patient from the rest of the system.
  • Fig. 2 is a drawing of a system 20 comprising a globe gantry 21.
  • the arms of the globe gantry form part of a circle, and the external source of radiation 24 can latitudinally rotate along an arm of the gantry.
  • the locus of the movement of the source of radiation is generally part of the surface of a sphere, rather than a circle.
  • the radiation beam emitted from the external source of radiation 24 points to the origin of the sphere, the radiation intensity can be varied, and the aperture of the radiation field can be changed.
  • the patient can also be moved, allowing the rotational isocenter of the radiation beam to scan through the target in the patient analogously to three-dimensional printing or painting, thereby covering an irregularly shaped target (e.g., tumor) with the desired dose patterns.
  • an irregularly shaped target e.g., tumor
  • Fig. 4(a) shows a side view of a radiation treatment system 20 when the at least one source of radiation 24 mounted on an arc-shaped, gantry support arm 23 is latitudinally rotated to near the rear (closed) end of the globe gantry 21. Because it is rarely desirable to direct the radiation beam towards the vertex of a patient's head or the bottom of a patient's feet, the latitudinal angle ( ⁇ ) practically need not be smaller than about 30°.
  • Fig. 4(b) shows a side view of a radiation treatment system 20 when the at least one source of radiation 24 mounted on an arc-shaped, gantry support arm 23 is latitudinally rotated to near the front (open) end of the globe gantry 21.
  • the latitudinal angle ( ⁇ ) practically need not be greater than about 120°.
  • Fig. 5 shows a radiation treatment system 20 when viewed from the front open ring 22.
  • the globe gantry 21 can rotate smoothly, for example, on ball bearings in the support base 27.
  • the radiation head 24 is rotated to a longitudinal angle ( ⁇ ).
  • the external source of radiation 24 can be any suitable source of radiation.
  • the external source of radiation 24 can be a self-contained radiation machine.
  • sources of radiation 24 include, but are not limited to, a linear accelerator and a radioisotope teletherapy device, such as a cobalt-60 teletherapy head.
  • the external source of radiation 24 is a linear accelerator
  • the microwave power generator and/or amplifier for electron acceleration, the accelerator waveguide, as well as other necessary components for shaping the radiation field are preferably all mounted on a single carrier, moving together as the source of radiation is latitudinally rotated.
  • the high-voltage pulse generation modulator and other control circuitry can either be fixed on the globe gantry or placed inside the rear stationary housing.
  • the external source of radiation 24 comprises the necessary shielding around the radiation source, a primary collimator, and a radiation aperture-shaping device, such as a multi-leaf collimator.
  • the beam of radiation is collimated with the primary collimator.
  • a multi-leaf collimator shapes the field of radiation dynamically during irradiation and movement.
  • the external source of radiation 24 is coupled with a beam stopper, which is mounted on at least one arc-shaped, gantry support arm 23 on the opposite side of the globe gantry 21 from the external source of radiation 24.
  • the beam stopper is a radiation-shielding plate that attenuates the exit beam from the patient.
  • suitable beam stoppers include, for example, a high-density material, such as lead encased in steel or tungsten alloy.
  • the beam stopper can act as a counter-weight to the external source of radiation 24.
  • the beam stopper can move along the length(s) of the arc-shaped, gantry support arm(s) 23 to which it is mounted and moves in the opposite direction of the external source of radiation 24. Since the external source of radiation 24 moves at a constant speed or a variable speed, the beam stopper moves at a constant speed or a variable speed accordingly. The ability of the beam stopper to move helps to minimize the size of the beam stopper required to block the exit of the radiation beam from the patient.
  • the beam stopper moves from a negative latitudinal angle to a positive latitudinal angle (and vice versa ) so as to maintain its function of blocking the exit beam from the patient.
  • the beam stopper can be a fixed, arc-shaped plate that connects the front opening ring 22 to the rear, rotational axle 25, serving both as a shield of the radiation exiting from the patient and as structural support providing rigidity to the globe gantry 21.
  • the width and the circular arc length of the shielding plate in this alternative embodiment are sufficient for shielding the exit beam when the radiation head is at any possible location on the globe gantry.
  • a patient platform 28 is a table or a couch.
  • the patient platform 28 can be independently moved in various directions.
  • the patient platform 28 can be moved in either direction along the length of the patient platform 28 or z-dimension, in either direction along the width of the patient platform 28 or x-dimension, and/or in either direction above or below the patient platform 28 or y-direction.
  • Such movements are in synchrony with the longitudinal and latitudinal rotations of the external source of radiation.
  • Independent movement of the patient platform 28 in three directions can be driven by at least three motors, for example.
  • Any suitable patient platform support 29 can be used to support the patient platform.
  • An example of a suitable patient platform support 29 is a pedestal, inside of which the driving mechanisms for the patient platform movements are arranged.
  • the patient platform support 29 allows the patient platform 28 to be suspended inside the globe gantry 21.
  • the patient platform support 29 can also be a multi-axis robotic arm.
  • the support base 27 can be any suitable supportive structure, such as a solid platform, that stabilizes the front opening ring 22, the rear, rotational axle 25, and, if desired, the patient platform 28, for better geometric stability.
  • a patient may prefer an opaque shield when a target in the head/neck region is being irradiated so as to hide the movement of the source of radiation 24 near the patient's face.
  • the shield can be made from any suitable material.
  • the shield is shatterproof and radiation-tolerant.
  • a plastic such as polycarbonate, can be used and even preferred.
  • the shield should be as thin as possible to minimize scatter radiation, which can increase the radiation dose to the skin.
  • the thickness of the shield is about 1 mm or less.
  • the system 20 can further comprise the following components: (v) at least two straight support beams 31, (vi) an x-ray tube 32, and (vii) an x-ray detector array 33 as shown in Figs. 11(a) and 11(b) .
  • Fig. 11(a) shows a side view of a system 20 in which straight support beams 31 are attached to the globe gantry 21 through a separate axle 36, which is co-axial with and independent from the axle of the globe gantry 25, to facilitate on-board imaging, such as 2-D x-ray or 3-D CT imaging, wherein on-board imaging with an x-ray tube 32 and an x-ray detector array 33 is shown.
  • Fig. 11(a) shows a side view of a system 20 in which straight support beams 31 are attached to the globe gantry 21 through a separate axle 36, which is co-axial with and independent from the axle of the globe gantry 25, to facilitate on-board imaging, such as 2-D x-ray or 3-D CT imaging, wherein on-
  • FIG. 11(b) shows the view from the front ring 22 of the globe gantry 21 of a system 20 in which straight support beams 31 are attached to the globe gantry 21 to facilitate on-board imaging with an on-board imaging device 32 , such as 2-D x-ray or 3-D CT imaging, wherein on-board imaging with an x-ray tube 32 and an x-ray detector array 33 is shown.
  • the array can be one-dimensional or multi-dimensional.
  • the x-ray tube 32 is mounted on at least one straight support beam on one side of the globe gantry.
  • the x-ray detector array 33 is mounted on at least one straight support beam on the opposite side of the globe gantry from the x-ray tube.
  • the two straight support beams are supported at the front end by a bearing mounted on the front ring of the globe gantry and at the rear end by a bearing 36 that is coaxial with, but separate from, the rear rotational axle of the globe gantry.
  • the two straight support beams can rotate independently, i.e., longitudinally independently, of the rotation, i.e., longitudinal rotation, of the globe gantry.
  • the x-ray tube and the x-ray detector array can move along the lengths of the at least two straight support beams 31 to which they are mounted in synchrony.
  • the system 20 can further comprise the following component: (viii) a computed tomography (CT) imaging system, a magnetic resonance imaging (MRI) system, or a positron emission tomography (PET)/computed tomography (CT) imaging system positioned adjacent to the front opening ring 22 of the globe gantry 21 as shown in Fig. 12 , which illustrates how a three-dimensional imaging device on a ring gantry can be abutted at the front ring 22 of the globe gantry 21 of a system 20 to allow a patient to be imaged and treated while maintaining the same position on a patient platform.
  • CT imaging system, the MRI system, or the PET/CT imaging system can provide on-board imaging guidance.
  • the same patient platform ( 28 or 28 and 29 ) is used for imaging and irradiation to minimize geometric uncertainty. Therefore, the patient can be imaged and treated without moving the patient from a fixed position on the patient platform ( 28 or 28 and 29 ).
  • a method of irradiating a target in a patient under image guidance using a system 20 as described herein comprises a) imaging the patient in the treatment position, using the x-ray tube and x-ray detector complex or using the attached or adjacent volumetric imaging systems (CT, MRI, or PET/CT); b) developing a treatment plan to deliver a focal radiation dose by directing intensity-modulated beams of radiation from the external source of radiation at the target in the patient in a treatment position from numerous directions in a broad solid angle by longitudinally rotating the external source of radiation around a central axis and simultaneously or sequentially, in either order, latitudinally rotating the external source of radiation, while continuously or discontinuously moving the patient; c) delivering the treatment according to the treatment plan with the patient remaining on the patient platform of the same setup as with imaging in a); and d) during radiation treatment, imaging the patient using the x-ray tube and the x-ray detector array mounted on the straight support beams on opposite sides of the patient, wherein,
  • a treatment plan can be, and desirably is, used to govern the movement of the globe gantry 21, the source of radiation 24, and the patient platform 28.
  • the coordination of all the movements and irradiation is reflected in the treatment plan and executed by the central control unit, which comprises a computer system and interfaced pulse frequency controllers and motion controllers.
  • the central control unit comprises a computer system and interfaced pulse frequency controllers and motion controllers.
  • Such control units are commonly employed in the medical linear accelerators made by skilled artisans in the field.
  • the treatment plan is designed by a treatment planning system that uses 3-D images of the patient and all the freedom provided by the system described herein to determine the best possible dose distribution.
  • the planning procedure can, and typically does, involve computer optimization commonly referred to as "inverse planning.”
  • the treatment plan is then digitally transferred to the system 20 and translated to machine control code that drives the delivery of radiation and the movement of different components of the system and the patient support platform.
  • the system 20 and method can be configured to make stereotactic irradiation devices that are dedicated to a particular disease site.
  • the resulting system 20 can be used as an irradiation device dedicated for treating head (e.g., brain) and neck tumors as shown in Fig. 7 , which illustrates a system 20 configured as a dedicated device for treating the brain and head and neck tumors where the ranges of the latitudinal angles at the front and rear ends of the globe gantry 21 are highly asymmetric about the transverse plane across the origin of the globe.
  • most or all beams would be directed from the rear hemisphere of the globe gantry.
  • the smaller radius, R allows the dose rate to be increased.
  • the ranges of the latitudinal angles of the globe gantry 21 can be smaller than the general purpose systems, for example, from about 40° to about 110°, making most beams aiming from the superior side of the patient. Because the radius is smaller, the globe gantry 21 weighs less, and the supporting structures can be simplified by using, for example, a single, central supporting column 36.
  • a torque motor 34 with its stator fixed to the support column 36 and its rotor fixed to the rear, rotational axle can be used to drive the longitudinal rotation.
  • One of ordinary skill in the art can use different mechanisms from the torque motor 34 to effect longitudinal rotation.
  • the supporting base 27 below the front opening ring 22 can be eliminated.
  • the patient naturally looks out the front opening.
  • the latitudinal range can take further advantage of the geometry of the human head such that most or all beams enter from the upper hemisphere of the head, coinciding with the rear end of the globe gantry 21.
  • the system 20 can be used for treating cancers in a human breast pendent through an opening in the patient platform 28 as shown in Fig. 8 , which illustrates a system configured as a dedicated device for treating cancers in a human breast pendent through an opening in a patient platform 28 positioned above the opening of the globe gantry 21 , the longitudinal axis of rotation of which is substantially vertical or vertical.
  • the patient platform 28 lies above the front opening ring 22 and is supported and driven to make movements in all three directions (i.e., x, y and z axes).
  • the structure that supports the longitudinal rotational axle and the rear housing 26, which contains the power supply and controllers, is attached to a rotatable axle, which is supported, for example, by two supporting columns 36, which are separated enough for the rear housing 26 to swing in between the supporting columns 36, thereby allowing the longitudinal axis of the globe gantry 21 to be either horizontal or vertical for treatment of the head/neck and breast, respectively, for example.
  • the patient can be treated in either "head-in” or "feet-in” orientation. Therefore, the distance from the origin of the sphere (the isocenter) to the very rear end should not need to be substantially more than about 1 meter to allow irradiation of targets throughout the body. Since the use of beam directions substantially parallel to the patient's axis is not desired, the smallest latitudinal angle, ⁇ , is about 40° (50° beyond the central transverse plane of the globe gantry). This allows additional space to be made available in the closed, rear end of the globe gantry 21 as shown in Fig.
  • FIG. 10 which illustrates an embodiment of the globe gantry 21 in which a recess at the rear end of the globe gantry 21 provides space for a patient's feet when treated in a "feet-in" orientation, such as for treatment of prostate cancer.

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Claims (12)

  1. Portique en forme de globe (21) permettant de faire tourner longitudinalement et latitudinalement au moins une source externe de rayonnement concentriquement autour d'un isocentre placé dans une cible à exposer au rayonnement, lequel portique en forme de globe a un axe central coupant l'isocentre et qui comprend les éléments constitutifs suivants :
    (i) un anneau d'ouverture avant (22) ayant son origine sur l'axe central du portique en forme de globe,
    (ii) au moins un bras arqué (23) de support de portique, qui a une extrémité avant et une extrémité arrière et qui fait partie d'un cercle,
    (iii) une source externe de rayonnement (24), qui est montée sur l'au moins un bras arqué (23) de support de portique et qui peut se déplacer le long du bras arqué (23) de support de portique pour faire une rotation latitudinale autour de l'isocentre,
    (iv) un essieu de rotation arrière (25) ayant un axe le long de l'axe central du portique en forme de globe,
    (v) une base de support (27), et
    (vi) un logement arrière (26) comprenant une source d'alimentation, des mécanismes pour déplacer les éléments constitutifs du portique en forme de globe, et des organes de commande pour commander le mouvement des éléments constitutifs du portique en forme de globe et l'exposition au rayonnement de la cible dans le patient, dans lequel l'anneau d'ouverture avant (22) est fixé à l'extrémité avant de l'au moins un bras arqué (23) de support de portique, dans lequel l'essieu de rotation arrière (25) est fixé à l'extrémité arrière de l'au moins un bras arqué (23) de support de portique, dans lequel l'anneau d'ouverture avant (22) et l'essieu de rotation arrière (25) sont supportés par la base de support (27) et le logement arrière (26), et dans lequel l'anneau d'ouverture avant (22) et l'essieu de rotation arrière (25) peuvent tourner autour de l'axe central, ce qui amène la source externe de rayonnement à tourner longitudinalement.
  2. Portique en forme de globe selon la revendication 1, comprenant en outre une butée de faisceau, qui est montée sur l'au moins un bras arqué (23) de support de portique sur le côté opposé du portique en forme de globe (21) à partir de la source externe de rayonnement (24).
  3. Portique en forme de globe selon la revendication 1 ou 2, dans lequel la source externe de rayonnement (24) est un accélérateur linéaire ou un dispositif de téléthérapie à radioisotopes.
  4. Portique en forme de globe selon l'une quelconque des revendications 1 à 3, dans lequel la source externe de rayonnement (24) peut se déplacer sur la longueur de l'au moins un bras arqué (23) de support de portique sur lequel elle est montée à une vitesse variable.
  5. Portique en forme de globe selon l'une quelconque des revendications 1 à 3, dans lequel la source externe de rayonnement (24) est fixée sur au moins un bras arqué (23) de support de portique, et le bras arqué (23) de support de portique et l'essieu de rotation arrière (25) sont déplacés par translation pour amener la source de rayonnement externe à tourner latitudinalement à vitesse variable.
  6. Portique en forme de globe selon l'une quelconque des revendications 1 à 5, dont l'orientation de l'axe central peut être modifiée d'une position horizontale à une position verticale ou sensiblement verticale, auquel cas le logement arrière (26) peut tourner longitudinalement et pivoter entre les positions horizontale et verticale au même titre que le portique en forme de globe.
  7. Portique en forme de globe selon l'une quelconque des revendications 1 à 6, qui comprend au moins deux bras de support de portique, qui sont séparés par des angles longitudinaux de 180° ou au moins deux paires de bras de support de portique adjacents, lesquelles paires sont séparées par des angles longitudinaux de 180°.
  8. Système permettant d'exposer à un rayonnement une cible dans un patient, lequel système comprend les éléments constitutifs suivants :
    (i) le portique en forme de globe selon l'une quelconque des revendications 1 à 7,
    (ii) une plateforme patient (28), qui est positionnée parallèlement à l'axe central du portique en forme de globe et qui comprend une première extrémité et une seconde extrémité,
    (iii) un support (29) de plateforme patient, qui supporte la plateforme patient, et éventuellement,
    (iv) un écran de protection, qui sépare le patient du portique en forme de globe et de la ou des sources de rayonnement du système.
  9. Système selon la revendication 8, dans lequel la plateforme patient (28) peut être déplacée indépendamment dans l'une ou l'autre direction dans le sens de la longueur de la plateforme patient, ou dimension z, dans l'une ou l'autre direction le long de la largeur de la plateforme patient, ou dimension x, et/ou dans l'une ou l'autre direction au-dessus ou au-dessous de la plateforme patient, ou direction y, et de tels mouvements sont synchrones avec les rotations longitudinale et latitudinale de la source externe de rayonnement.
  10. Système selon la revendication 8 ou 9, dont les éléments constitutifs comprennent en outre :
    (v) au moins deux barres de support rectilignes (31),
    (vi) un tube à rayons X (32), et
    (vii) un réseau de détecteurs de rayons X (33),
    dans lequel le tube à rayons X (32) est monté sur au moins une barre de support rectiligne (31) d'un côté du portique en forme de globe, dans lequel le réseau de détecteurs de rayons X (33) est monté sur au moins une barre de support rectiligne (31) de l'autre côté du portique en forme de globe à partir du tube à rayons X, et peut se déplacer sur les longueurs des au moins deux barres de support rectilignes sur lesquelles ils sont montés, et dans lequel les au moins deux barres de support rectilignes sont parallèles à l'axe central du portique en forme de globe et sont supportées au niveau de l'extrémité avant par un palier monté sur l'anneau avant du portique en forme de globe et au niveau de l'extrémité arrière par un palier qui est coaxial avec l'essieu de rotation arrière du portique en forme de globe, mais séparé de celui-ci, de façon à tourner indépendamment de la rotation du portique en forme de globe.
  11. Système selon la revendication 10, dans lequel le réseau de détecteurs de rayons X (33) est unidimensionnel ou pluridimensionnel.
  12. Système selon la revendication 10 ou 11, dont les éléments constitutifs comprennent en outre (viii) un système d'imagerie à tomodensitométrie (TDM), un système d'imagerie par résonance magnétique (IRM), ou un système d'imagerie à tomographie par émission de positons (TEP)/tomodensitométrie (TDM) fixé à ou positionné adjacent à l'anneau d'ouverture avant du portique en forme de globe, de manière coaxiale ou non, le système d'imagerie TDM, le système IRM ou le système TEP/TDM fournissant un guidage d'imagerie embarqué.
EP15704112.0A 2014-01-05 2015-01-05 Système pour une arcthérapie stéréotaxique à intensité modulée Active EP3089787B1 (fr)

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US9155912B2 (en) 2015-10-13
CN105916555A8 (zh) 2017-02-01
US20150190658A1 (en) 2015-07-09
CA2935418C (fr) 2023-10-31
EP3089787A1 (fr) 2016-11-09
CN105916555B (zh) 2020-01-17
WO2015103564A1 (fr) 2015-07-09
JP6548665B2 (ja) 2019-07-24
ES2676074T3 (es) 2018-07-16
US20160325119A1 (en) 2016-11-10
JP2017504449A (ja) 2017-02-09
CN105916555A (zh) 2016-08-31
CA2935418A1 (fr) 2015-07-09

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